Remote monitoring of cardiac implantable electronic devices in Australia, barriers and enablers of routine clinical practice implementation (Preprint)

BACKGROUND The use of remote monitoring technology for patients with cardiac implantable electronic devices (CIED) is the standard of care as highlighted by international guidelines. However, remote monitoring has not yet been integrated to universal, routine clinical practice. OBJECTIVE We aimed to identify barriers and enablers of routine implementation of CIED remote monitoring. METHODS We conducted semi-structured interview to explore the barriers and enablers encountered when incorporating remote monitoring to CIED management. Participants included a broad range of stakeholders including cardiologists, cardiac clinicians/physiologists, nurses and patients. Interviews were transcribed verbatim and analysed through inductive thematic analysis and deductive approaches. We used the theoretical domains framework to understand barriers and enablers through an implementation science lens. Our study aligns with the COnsolidated criteria for REporting Qualitative (COREQ) research checklist. RESULTS 35 interviews were conducted, including 16 patients, 10 cardiologists, and 9 cardiac physiologists and nurses. Five main themes and 13 subthemes were identified. The five main themes and the associated subthemes were 1) Patient benefits from remote monitoring, such as improved CIED and Cardiovascular management, and improved patient-centred care; 2) Insufficient allocation of CIED remote monitoring resources, which included insufficient funding and staffing, insufficient reimbursement, infrastructure and access inequity; 3) Suboptimal management of data which includes inconsistent workflow, lack of guidance for clinic staff and has resulted in an increased alert burden; 4) Insufficient patient education post-CIED implant, this was attributed to limited healthcare worker availability and resulted in inadequate patient knowledge and anxiety associated with remote monitoring; and 5) Patient engagement with CIED management, which included the need for increased patient interaction and ability to share data with patients. These subthemes were mapped to 6 specific domains of the theoretical domains framework: ‘Beliefs about capabilities’, ‘Environmental Context and Resources’, ‘Beliefs about consequences’, ‘Knowledge’, ‘Emotions’, and ‘Goals’. CONCLUSIONS Patient engagement was identified in 3 of the 5 themes describing barriers and enablers to RM. These highlight the importance of addressing patient engagement with RM to better implement and integrate the use of RM into routine clinical practice. Barriers and enablers extend across multiple domains and suggest a multi-pronged approach is required to translate the gold standard care of remote monitoring to routine clinical practice.